Complications of Female to Male Chest Reconstruction
- Poor scarring
Ideally scars settle down to be a thin white line however on occasions they can remain red and thickened. Rarely, keloid scars can form. These can prove troublesome to treat
Any surgical wound can become infected; antibiotics are administered at the beginning of the procedure to reduce this risk.
The breast is naturally a very vascular organ. Blood vessels are sealed during the operative procedure but, on occasions, one may open up soon after, (24 to 48 hours). The use of a drain helps reduce the risk of a haematoma, which is a collection of blood in an operative site that may require drainage.
The scars on the left and right will not be exactly symmetric (no one’s body is). Any difference should be minimal and become less obvious as the scars mature and fade.
- Free nipple graft failure
If the graft fails the resulting wound will be allowed to heal by secondary intention. Nipple tattooing is then possible.
- Dog ears
Dog ears, (puckering), at the end of the mastectomy scar is possible, especially if the original breast is very large. Any puckering that does not settle down after a number of months may be revised under local anaesthetic.
Occasionally fluid can collect at the site of your operation for some weeks after. The binder may help to prevent this but if you do notice more swelling you should make contact with Mr Fitton. Occasionally the fluid is drained off using a needle. The procedure is no worse than having a blood test. Sometimes this has to be repeated a week or so later.
On the day of Surgery
You will be asked to come to the ward on the day of surgery where you will be taken to your room. Mr Fitton, the nursing team and the anaesthetist will visit you.
Mr Fitton will mark your chest and finalise the arrangements for your operation.
At the appropriate time you will be taken to the anaesthetic room and then into the operating theatre for the procedure.
The procedure usually takes between 90 and 120 minutes.
After your operation you will be transferred to the recovery suite before being returned to the ward.
Mr Fitton will review you after surgery and then again, the following morning. If appropriate the drains will be removed at this stage and discharge can be organised for later on in the day. If the amount of drainage is too great for their removal, you will be asked to stay for the drains to be removed the following morning.
When you leave the hospital the Resident doctor and the nurse team will ensure you have all your instructions and tablets to take away with you.
It is beneficial to wear a snug surgical binder for at least a fortnight following surgery. This helps reduce swelling and also supports the scars. You can either provide their own, new and not previously worn garment or supply us with chest measurements so that we can order one for you.
We will arrange to see you again in the out-patient department about 10 days after your surgery when your dressings will be removed and your wound checked. We therefore ask you to keep the dressing dry for the first 10 days but by all means wash yourself by either sitting in a shallow bath of water or using a flannel. Assuming all is well further follow-up will either be with the GP or, if you wish, with Mr Fitton again.
Bilateral mastectomy is a significant undertaking for patients, both physically and psychologically. Some form of fatigue can be expected for up to 6 weeks.
It is imperative not to take to one’s bed or sit for prolonged periods. Deep vein thrombosis, subsequent pulmonary embolus and its implications are more common in those patients who do not mobilise. Drinking regular volumes of water is also beneficial.
Arm and shoulder physiotherapy is important and can be self-directed. Placing one’s hands on one’s head, reaching behind to the spine or over to the opposite shoulder with each arm helps maintain the suppleness of the shoulder joint. Standing next or wall and walking the hand up the wall is also beneficial.
Activities such as swimming or extreme gym attendance should be curtailed for six weeks.